Report warns against overuse injuries

Published 12:00 am Thursday, January 23, 2014

Ryan Brennecke / The Bulletin file photoZach Emerson (in white) fights for possession of the ball against Bend's Sam Nelson during a soccer game in October 2013. Emerson trains year-round, but said he leaves at least one day a week for rest.

Regardless of what month it is, you can bet Zach Emerson is training for a sport.

In addition to his regular soccer schedule at Mountain View High School in Bend, the sophomore plays on an international soccer league. He’s considered among the top 32 soccer players worldwide younger than 16. He plays football and does track, too.

New overuse injury and burnout prevention guidelines published this month by the American Medical Society for Sports Medicine are directed at those who have influenced Emerson and young athletes like him: parents, coaches, health care professionals.

Youth sports, while important for developing self-esteem, fitness and socialization, increasingly have come to emphasize competitive success, a phenomenon driven by aspirations of elite-level travel team selection, college scholarships or national and professional contracts, according to the AMSSM report. That’s led to higher-intensity training at younger ages and, consequently, more overuse injuries and burnout.

Emerson — who started playing soccer when he was 5 — agreed there’s pressure from coaches, parents and friends. But in the end, he said, his competitive edge comes from within.

“I think I put a lot of pressure on myself to get to where I want to be,” he said.

Recommendations

Take breaks, both annual and weekly.

Scheduled rest is a crucial component of any training regimen, said AMSSM President John DiFiori. At least one day per week in addition to time during the year when the athlete takes a break from the sport is a good rule of thumb, he said.

“In other words, training is not just go, go, go, go, go,” he said. “There has to be periods of recovery to allow for adaptation to the demands of the sport and to allow for continued progress.”

Rest helps prevent injury, longterm burnout and negative effects on the child’s stress level, said DiFiori, also the chief of the division of sports medicine and nonoperative orthopedics at University of California, Los Angeles Health.

“They may perceive the activity as more stressful than enjoyable,” he said, “and that’s when we start to see kids losing interest in their sport.”

Athletes ages 8 to 18 who spend twice as many hours per week playing organized sports than in free play were more likely to be injured, according to an October 2013 study by Loyola University Medical Center researchers. The study, which involved more than 1,200 young athletes, also found that athletes who played more hours per week than their age — a 10-year-old who played more than 10 hours per week, for example — were more likely to be injured.

Emerson said he gives himself at least one day of rest per week. He said he encourages other young athletes to take rest days if they’re feeling tired or overwhelmed, and don’t let your sport cause you to fall behind on schoolwork.

Don Emerson, Mountain View’s girl’s varsity soccer coach and Zach Emerson’s dad, agrees.

“Year-round training I think is detrimental,” he said. “They need breaks. They need to be kids.”

Don’t specialize too early.

Public perception tends be that specializing in one sport guarantees long-term success, DiFiori said. Unfortunately, that’s not supported by scientific literature and can increase one’s risk of injury or ultimate loss of interest in the sport.

It also takes away the child’s ability to explore other activities as they grow older, he said.

The fight against early specialization is one that Don Emerson said he feels like he’s been fighting for years — and is still fighting. When Zach was growing up, Don said other kids were joining year-round soccer programs, but he encouraged his son to try other sports. Zach said he tried baseball, soccer, football, basketball and track. He continues to play football, run track and, until this year, he played basketball.

Even if you’re leaning toward playing one sport, playing other sports will strengthen different muscle groups and ultimately will help with your main sport, Zach said.

In the Loyola University Medical Center study, 837 of the participants became injured and 360 were uninjured. Those who were injured reported significantly higher levels of specialization than those who weren’t injured, with adjustments for hours per week in sports activities and age.

Exceptions may exist in technical sports that require elite-level competition prior to reaching one’s full potential, such as gymnastics, figure skating or swimming or diving, according to the AMSSM.

But in most cases, while some have suggested 10,000 hours of training is necessary to reach elite-level status, the AMSSM says it’s actually far less. In fact, the researchers found, diversifying the sports played during early and middle adolescence may actually be a more effective strategy toward developing elite-level skills in one’s main sport due to the transfer of recall skills from one sport to another.

Diversification makes athletes stronger and it builds different muscle groups, said Don Emerson.

“It just makes for more well-rounded, smarter athletes,” he said.

Fierce competition

Youth sports are much different today than they were when Melanie Embree was growing up.

“We had a little six-week or three-month season and then went on to the next thing,” said Embree, a physical therapist and owner of Momentum Physical Therapy in Bend. Today, “kids are put into travel ball and start playing one sport six to eight months a year, some of them year-round. It’s more competitive.”

No one walks through Embree’s door without hearing her warnings against overtraining and early specialization. They’re lessons that aren’t learned overnight, especially among kids who’ve spent much of their lives training in a certain way, she said.

This month and through February, Embree is hosting classes for middle- and high-school student athletes to teach them training regimens designed to reduce the risk of overuse injuries. The classes, focused on upper-extremity sports like baseball, softball, volleyball, lacrosse, tennis and some track-and-field events, will focus on increasing body awareness and strength training, she said.

Most local athletic training classes emphasize strength and conditioning, with an emphasis on Olympic weight-lifting, Embree said.

“This is not that class,” she said. “That’s a different philosophy for training overhead athletes, one that I don’t believe in.”

Momentum’s program will teach a more functional style of strengthening based on the so-called kinetic chain principle of force production, which refers to using the body’s energy from the ground up rather than only the upper or lower extremities. Embree says to picture the shoulders, elbows and wrists as downstream joints. If they’re not receiving enough kinetic energy from the legs, hips and torso, they’ll try to make up for it.

“That’s why we see all the injuries in the shoulder, hip and elbow,” she said. “It’s not necessarily coming from just the shoulder. It may be coming from very weak hips or a very weak core.”

Embree’s classes, which will be divided into age groups, will involve watching the kids’ movements to ensure all of the big muscle groups in the legs and hips aren’t causing the upper extremities to overcompensate.

The reasons behind the increased competition are complex and numerous, DiFiori said. It’s possible that some parents, faced with dwindling savings to send their kids to college with, could be banking on the hope that their kids will pay for their own education through athletic scholarships.

But considering the costs involved in children participating in a sports — team fees, uniforms, travel, hotels, meals — it ends up being a substantial investment, especially considering the odds are against a child receiving an NCAA Division 1 scholarship, DiFiori said.

“So, while I do think that the idea of a college scholarship is often a driving factor, it may not always be just the financial aspect of it,” he said, “or perhaps it is and parents don’t quite understand the facts and realities.”

In some cases, parents are drawn to the prestige of having a kid who’s good enough to be recruited, DiFiori said. In others — like in the case of Zach Emerson — it might be the young athlete himself or herself.

“There are a lot of kids out there that are really competitive, and they’re driving the ship,” he said. “They want to excel at the highest level they possibly can.”

— Reporter: 541-383-0304,

tbannow@bendbulletin.com

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